The diagnosis of Fetal Alcohol Syndrome (FAS) can be made through a combination of factors (history of alcohol exposure, neurodevelopmental delays, microcephaly) including evaluation of the facial features of a child for the classic triad, i.e. poorly developed philtrum, thin upper lip, and small palpabral fissures. When considering international adoption, it is prudent to evaluate children living in orphanages abroad for FAS. The standards for an FAS evaluation only apply to children who are Caucasian and African-American. Children who do not fulfill the criteria for classic FAS, may still have been exposed to alcohol and the suspicions of this may not evolve until a number of years later when the child is found to be delayed.

Dr. Aronson is an “old hat” at diagnosing FAS from photos sent from abroad, however, she will be unable to diagnose any child if the photos are not done properly. For example, one of the facial features of FAS is a smooth philtrum (that tiny groove just under the nose that is particularly hard for men to shave); a smiling child may appear to have a smooth philtrum because his/her smile erases the appearance of a philtrum. Try smiling while looking in a mirror and you can see for yourself.

Without proper photos of a child, it is not possible to diagnose FAS without physically examining the child in the doctor’s office. Therefore, this guide is meant to be an instructive tool for adopting parents to use when taking photos of their prospective child when they are in the orphanage. It can also be used by agencies referring children to prospective parents.

Photos Needed

Dr. Aronson has literally reviewed thousands of photos to diagnose FAS.
A portrait, ¾ view, and a lateral view (profile), either right or left, are necessary for proper assessment. They need to be taken with the appropriate positioning and without any expression on the child’s face (see below).
Also, a digital camera is recommended (3 megapixels or greater). If you use a digital camera, please be sure that the photos are in either a .jpg (jpeg), .tif (tiff), or .bmp format. If you use a film camera, please use a 35mm film camera with a portrait lens for greater quality. Polaroid pictures cannot be used to assess FAS, as they lack clarity.

Positioning

There are some basic guidelines for all of the photos. The mouth needs to be closed when the picture is taken, and there shouldn’t be even the slightest hint of expression on the child’s face. Expression can easily wash away the facial features. Also, there should be sufficient light to see the face clearly; a flash may be used. Examples for all three positions are below.

For the portrait shot, the child’s should be facing directly towards the camera with the head occupying the entire frame. The camera should not be looking either up or down at the child’s face, but straight on. If you were to draw a horizontal line across the face from the opening of one ear to the other, it should cross the bottom of the eye socket (feel the bottom of your own eye socket and at the very lowest part you should feel where the bone dips down just a bit; this is where the horizontal line should cross the face). The camera angle should reflect this for the portrait shot.

The lateral or profile shot is a photo from either side. As was the case with the portrait shot, the camera angle should be straight on with the head filling the frame. The photo should be taken directly from the side, not looking at the top or bottom of the head and face. To put it another way, if the child was standing straight up, the face should be perpendicular to the floor.

The ¾ shot is like a combination of the profile and portrait shots. The child’s face should be facing about 45 degrees away from you so that the facial features cast shadows across the face. For example, the nose will cast a shadow across the far side of the face. The idea is to highlight the ridges and grooves of the face in lights and shadows.